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Sections Hepatocellular Adenoma (Hepatic Adenoma)
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Questions & Answers
- References
History
The clinical presentation of hepatocellular adenoma (HCA) (hepatic adenomas) varies widely. Salient features of the history and physical examination may include the following:
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Pain may be present in the right upper quadrant or epigastric region.
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Patients may notice a palpable mass. Lesions may also be discovered incidentally during an abdominal imaging study for an unrelated reason.
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History of birth control or anabolic steroid use should be elicited in patients with suspected HCAs.
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Patients may also present with severe, acute abdominal pain with bleeding into the abdomen, which results in signs of shock (eg, hypotension, tachycardia, diaphoresis).
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Hemoperitoneum occurs more frequently if the patient is taking a high-dose oral contraceptive pill (OCP), is actively menstruating or pregnant, or is within 6 weeks postpartum. Location of the lesion also is important, with those near the surface of the liver more prone to causing hemoperitoneum.
Physical Examination
The physical examination findings in patients with hepatocellular adenomas (HCAs) (hepatic adenomas) are often nonspecific. Patients may be asymptomatic, or they may appear ill, with pallor and abdominal distress. Note the following:
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Vital signs with tachycardia, hypotension, or orthostasis (concerning for active hemorrhage)
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Anicteric sclera (jaundice has been reported due to compression of the tumor on the biliary tree)
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Pale conjunctiva, if hemorrhage has occurred
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Right hypochondrial mass, with or without tenderness
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Hepatomegaly
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Fluid wave (in cases of hemoperitoneum)
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Peritoneal signs, including guarding or rebound in cases of tumor rupture
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Skin findings: Grey Turner sign or Cullen sign in cases of hemoperitoneum
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Tables
Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC
Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society
Disclosure: Nothing to disclose.
Janice M Fields, MD, FACG, FACP Assistant Professor of Internal Medicine, Oakland University William Beaumont School of Medicine; Consulting Staff, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital, St John Macomb-Oakland Hosptial
Janice M Fields, MD, FACG, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, National Medical Association
Disclosure: Nothing to disclose.
Ryan R Kahl, DO Chief Fellow, Department of Gastroenterology, Ascension Providence-Providence Park Hospital, Michigan State University College of Human Medicine
Ryan R Kahl, DO is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center
Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association
Disclosure: Nothing to disclose.
Bradford A Whitmer, DO Fellow, Department of Gastroenterology, Providence Hospital
Bradford A Whitmer, DO is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Osteopathic Association
Disclosure: Nothing to disclose.
Brian S Berk, MD Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of End Stage Liver Disease, Section of Gastroenterology, Dartmouth Hitchcock Medical Center
Brian S Berk, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association
Disclosure: Nothing to disclose. Kenneth Ingram, PAC Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University School of Medicine
Disclosure: Nothing to disclose.
Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership
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Sections Hepatocellular Adenoma (Hepatic Adenoma)
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Questions & Answers
- References
